Medicare beneficiaries in the state of Maine may wish to know more about prescription drug coverage. After all, approximately 90 percent of people over the age of 65 take at least one drug every week, yet Original Medicare (Medicare Part A and Part B) does not provide coverage for most prescription medications.1

Medicare beneficiaries have two primary options for obtaining coverage for prescription drugs. The first is enrolling a Medicare Advantage plan that provides such a benefit. The second option is enrolling in a standalone Medicare Part D plan.

Part D plans are used in conjunction with Original Medicare (and Medicare Advantage plans that don’t provide prescription drug benefits) to provide coverage exclusively for prescription drugs. Because these plans are sold by private insurers, each plan will include its own criteria concerning:

Premiums

Deductibles

Copayments or coinsurance

Drug formulary (the list of drugs covered by the plan)

ME Medicare Part D plans by the numbers

There were 233,896 people in the state of Maine enrolled in a Medicare Part D plan as of early 2018.2

There are 24 Medicare Part D plans available in Maine in 2018, which is three more than were offered in 2017. Each plan is unique in terms of its cost and coverage, so it’s important to find a plan that fits your needs.

The chart below highlights some details about the cost of Part D plans in Maine.

Average plan premium

$53.69 ($1.46 higher than the national average of $52.23)

Lowest premium

$12.60

Highest premium

$148.80

Average deductible

$225.21

No. of plans with a premium under $25

3

No. of plans with a $0 deductible

10

Data reflects Medicare Part D enrollment in the state of Maine as of 2018, as obtained from the Centers of Medicare and Medicaid Services, www.cms.gov.3

There are only certain times of the year in which you may sign up for a Medicare Part D plan or a Medicare Advantage plan, which are outlined below.

Initial Enrollment Period (IEP)

Your seven-month Initial Enrollment Period (IEP) begins three months before your 65th birthday, includes the month of your birthday and continues for three months after you turn 65. It typically runs concurrently with your Medicare Part B Initial Enrollment Period.

It’s important to consider that there is a Medicare Part D late enrollment penalty. You may incur this penalty if you go at least 63 continuous days without a Part D plan, a Medicare Advantage plan that offers prescription drug coverage or other creditable prescription drug coverage.

Annual Election Period

The Annual Election Period occurs from October 15 to December 7 each year. During this time, you may enroll or disenroll in a Medicare Part D plan or switch from one plan to another.

During this period, you can also enroll in a Medicare Advantage plan with prescription drug coverage, disenroll from a Medicare Advantage plan or switch from one Medicare Advantage plan to another.

Medicare Advantage Open Enrollment Period

The Medicare Advantage Open Enrollment Period lasts from January 1 to March 31 each year. During this time, you may disenroll from a Medicare Advantage plan and return to Original Medicare coverage. If you do so during this period, you can also enroll in a Medicare Part D prescription drug plan.

During this enrollment period, you can also switch from one Medicare Advantage plan to another, whether or not either plan offers prescription drug coverage.

Special Enrollment Period

A Special Enrollment Period may be granted under certain circumstances under which you can enroll in a Medicare Part D plan or in a Medicare Advantage plan. These specific circumstances can include but are not limited to: moving out of your current plan’s service area, losing your current coverage or moving into a long-term care facility.

5-Star Special Enrollment Period

There is also a 5-Star Special Enrollment Period, which runs from December 8 to November 30 each year. If you are enrolled in a Part D plan or a Medicare Advantage plan that does not have a 5-star rating, you can use this time to switch to one that does, as long as one is available in your area.4

Maine’s State Health Insurance Assistance Program (SHIP)

The State Health Insurance Assistance Program of Maine offers free health insurance counseling and assistance to Maine residents who have Medicare. The trained staff can help answer questions about benefits in order to help people better understand and optimize their Medicare coverage. The program may be reached at 877-353-3771 (or 800-750-5353 for TTY users).

You can also explore more information about the insurance industry in Maine by visiting the state’s Department of Insurance website.

1 Ruscin, Mark and Linnebur, Sunny. Aging and Drugs. Merck Manual. Retrieved from https://www.merckmanuals.com/home/older-people%E2%80%99s-health-issues/aging-and-drugs/aging-and-drugs.2 Cubanski, Juliette; Damico, Anthony and Neuman, Tricia. Medicare Part D in 2018: The Latest on Enrollment, Premiums and Cost Sharing. May 17, 2018. Kaiser Family Foundation. Retrieved from https://www.kff.org/report-section/medicare-part-d-in-2018-the-latest-on-enrollment-premiums-and-cost-sharing-tables.3 MedicareAdvantage.com’s internal analysis of CMS 2018 Prescription Drug Plan (PDP) Landscape Source Files. May 2018.4 Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC is a licensed and certified representative of A Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any plan depends on contract renewal.

TZ Insurance Solutions LLC and the licensed sales agents that may call you are not connected with or endorsed by the U.S. Government or the federal Medicare program. This website does not contain a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call (877) 486-2048), 24 hours a day / 7 days a week or consult www.medicare.gov.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.